Intended for healthcare professionals


Why India needs a national nutrition strategy

BMJ 2011; 343 doi: (Published 11 November 2011) Cite this as: BMJ 2011;343:d6687
  1. Lawrence Haddad, director
  1. 1Institute of Development Studies, Brighton BN1 9RE, UK
  1. l.haddad{at}
  • Accepted 9 October 2011

Rates of childhood undernutrition in India remain high despite rapid economic growth. Lawrence Haddad looks at the underlying factors and argues the case for a national nutritional strategy

Over the past 15 years India’s economic growth rate has been unprecedented. The International Monetary Fund reports an average growth in real gross domestic product (GDP) of nearly 6% in the 1990s and of 8% in 2000-10.1 The economic growth has not, however, been associated with corresponding reductions in the rates of childhood undernutrition.2 The National Family Health Survey, which provides India’s most authoritative statistics on nutrition status, showed that 43% of children under 5 years old were underweight for age in 1998-9; by 2005-6 the percentage had only dropped to 40%.3 At that rate of progress India will not reach its millennium development goal target (to halve the proportion of underweight children by 2015) until 2043.4 By contrast, China has already met its goal and Brazil is expected to do so by 2015.5

What is undernutrition?

  • Undernutrition is the outcome of interactions between inadequate food intake and repeated infectious diseases

  • Preschool children experience undernutrition if they are stunted (low height for age), underweight (low weight for age), or wasted (low weight for height)

  • Moderate undernutrition is experienced if a child’s height or weight is more than 2 standard deviations below the median value for age drawn from a healthy population (World Health Organization growth standards)

Undernutrition is responsible for 35% of deaths among children under 5 and 11% of the total global disease burden.6 It also reduces schooling attainment: an improvement in height for age z scores of 1 is a predictor of an extra half a year of schooling7 and substantially increases the likelihood of being poorer later in life since less schooling is a predictor …

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